Stand up for your health

In Denver and Fort Collins, activists with Health Care for All Colorado (HCAC) have just hosted 48th birthday celebrations for Medicare, the highly successful program that has provided comprehensive low-cost health care for older people and the disabled since 1965. HCAC wants a similar publicly funded “single payer” system for all Americans.

They are circulating a ballot petition for the 2014 election to establish a state constitutional right to health care. It asks voters to approve, “as a matter of human right and public good for all residing in Colorado, access to an appropriate single standard of high quality health care without financial barrier.”

It requires the legislature to create the framework for the universal system and the Colorado Department of Revenue to collect a premium that won’t exceed 9 percent of an individual’s income to fund it. This system could not be under the control of or administered by “a for-profit, nonpublic entity or corporation.” The initiative states, “Quality health care as a part of our individual and collective quality of life shall not be treated as a private, for-profit commodity in Colorado.”

HCAC has to collect 86,105 valid signatures by October to place the question on next year’s ballot. They are taking advantage of a provision in Obamacare (or ACA, the Affordable Care Act) that allows states to apply for a waiver to establish their own health care system.

Why should we support something like this? Why not wait to see if the ACA works? Because, unlike Social Security and Medicare, the ACA is a volatile compromise.

There are many good provisions, such as banning discrimination based on “pre-existing conditions,” free birth control and other preventive care, and allowing children up to 26 years to be included on their parents’ insurance policies.

However, there are serious concerns about costs. Particularly the growing trend of (euphemism alert!) “underinsurance.” This can mean not seeing the doctor when you are sick, not filling prescriptions, skipping diagnostic tests. It can also mean financial disaster. A recent study revealed that medical bills are the biggest cause of personal bankruptcies in this country. Three quarters of the “medical debtors” had health insurance at the time of their illness.

In an editorial in the “Journal of General Internal Medicine,” Steffie Woolhandler and David Himmelstein argue that the ACA may actually increase underinsurance.

“Obamacare is lowering the bar for health insurance,” said Himmelstein, a professor of public health at the City University of New York and a primary care doctor. “The new coverage sold through the insurance exchanges will leave many families paying 40 percent of their health costs out-of-pocket even after they’ve laid out thousands for premiums. And the administration is allowing states to institute co-payments under Medicaid, even for the poorest of the poor.”

He continued: “Under the ACA a 56-year-old making $46,100 will pay a premium of $10,585 for coverage through the exchange and still face up to $6,250 in co-payments and deductibles.”

Woolhandler, the lead author of the editorial, who is also a physician and professor of public health at CUNY, said, “Over the past 25 years the financial protection offered by health insurance has steadily eroded. The consequences are grave, not only financially but also medically. For instance, we know that heart attack patients who face high co-payments delay coming to the ER, threatening their lives.”

“Obamacare is making underinsurance the new normal,” said Woolhandler.

“It will reduce the number of uninsured from 50 million to 30 million, but the new coverage is full of holes. Americans deserve the kind of first-dollar, comprehensive coverage that Canadians already have. But that’s only affordable under a single-payer system that cuts out the private insurance middlemen.”

Barack Obama knows this. He strongly supported single payer when he was a state senator in Illinois. On the campaign trail and as president, he said single payer was the best system.

But he added that most people were “accustomed” to employer-based insurance.

Yes, and the vested interests in the private insurance industry, the for-profit hospitals and HMOs have become accustomed to making obscene profits and influencing the political process.

If we want change we can believe in, we’ll have to stand up for ourselves.

This opinion column does not necessarily reflect the views of Boulder Weekly.